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54 Cards in this Set
- Front
- Back
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1 Atm (mm Hg)
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760 mm Hg
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RRT
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Rapid Response Team
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PACU
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Post Anasthesia Recovery
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Using a Hyperbaric Chamber increases what?
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O2 carried in plasma from 0.3% to 6.2%
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TDP
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Therapist Drive Protocol (Christiana Hosp)
Therapist are allowed to use any means of keeping a pt SpO2 greater or equal to 92% Notify pt doctor after you have given treatment |
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Signs of Hypoxemia
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PCR's respond to O2
-Aortic Arch (trunk and extremeities) -Carotid Arteries(head) Pulm Response Cardiac Response Vascular Response General Response |
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Pulm. Response
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RR> 25/min
Vt only measured when pt is on a vent. -check for nasal flaring, acc. muscle use, labored breathing -check abs for forced exhalation (both are subjective) Increased RR and Vt will increase MV |
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Cardiac Response
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Any increase of 20 BPM above a pt baseline is a significant increase
If heart rate and BP increase, normally SV will increase BP 140/90 is considered Hypertensive Increased HR and SV will increase CO |
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Vascular Response
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Central
-Vasodialate heart, brain, and kidneys Peripheral -Vasoconstriction |
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UOP
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Urine Output
Normal -1mL/Min (50-60mL/min) <30mL is considere low (Oliguric or Oliguria) -HR will be low |
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General Response
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Non specific
Stimulation of the adrenal gland will secrete epinephrine (alert, awake, irritable pt.) Increased cerebral cortex stimulation |
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Goals of O2 therapy
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Treat hypoxemia to prevent hypoxia
Decrease the signs and symptoms pf hypoxemia (hypoxia) Decrease any increased work of breathing due to PCR stim. from hypoxemia |
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What is the treatment for a patient that has a Carbonmonoxide>10%?
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Put them on 100% O2 to prevent Acute Traumatic Brain Injury
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PaCO2 increase of 20 mm Hg will cause what effect onb pH?
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Decrease of 0.1
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Things that will shift the Oxyhemoglobin curve to the left...
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Increased pH
Decreased -PCO2 -Temp. -CarboxyHb -HbF -2, 3 DPG |
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Things that will shift the Oxyhemoglobin curve to the right...
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Decreased pH
Increased -PCO2 -Temp. -2,3 DPG |
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Causes of Hypoxia
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Hypoxemic Hypoxia
Hemic Hypoxia Stagnant Hypoxia Histotoxic Hypoxia |
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Cause of Hypoxemic Hypoxia
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Low Ambient FIO2
Hypoventilation Shunt-like-V/Q mismatch Diffusion defect True shunt |
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Normoxemia for pt over the age of 60
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Subtract i mm Hg from 80mm Hg for each year over 60
Ex. Normoxic 65 yo pt wld have PaO2 between 100-75 |
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What should be checked before and after O2 Therapy?
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Heart Rate and RR
Should also be trended during cont. of O2 therapy (used to check for effectiveness of the therapy) |
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What is usually evidence of compensation?
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Irritability rhythms (PVC's, and PAC's)
Hypertension >140/90 |
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What is usually evidence of decompensation?
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Suppression dysrhythmias (1st, 2nd, 3rd degree block)
Hypotension <90 mm Hg systolic |
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Cyanosis
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Blue, grey, slatelike appearance of the skin and/or mucum membranes
>5 gm% of Hb desaturation unreliable symptom of hypoxemia or hypoxia |
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Cynosis due to the cold happens because of...
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vasoconstriction
blue extremities, normal trunk |
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If the patient is hypoxemic or hypoxic but does not appear to be cyanotic...
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Anemia is present
Abnormal types of Hb exist *ex, CarboxyHb pt will be bright red |
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10 Symptoms of Hypoxemia
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Dyspnea
Restlessness Impaired Judgement Personality changes Headache Impaired motor function Confusion Delirium Coma Death |
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Inadequate amounts of Hb
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<8-10 gm %
Can be IDed with Hb and Hematocrit test or Complete blood count Treatment used to be transfusion current treatment is synthetic erythropoietin to stimulate bone marrow |
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Abnormal types of Hb
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CarboxyHb
-Carbon Monoxide binds to Hb (treat anything over 10%) MetHb -Caused by Nitrate poisoning (fertilizer) Fetal Hb ** Can be identified with Co-Oximeter |
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Blood transfusions increase pt risk of
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Infection
ARDS/ALI Mortality Morbidity |
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Causes of Hemic Hypoxia
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Inadequated amounts of Hb
Abnormal Hb |
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Affects of COHGB
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<20%
-usually asymptomatic -manageable 20%-60% -headache -exertional dyspnea -impaired judgement -nausea -vomiting *most will be send to Hyperbaric chamber *kept alive but most will have neurological problems >60% -Coma -Convulsions |
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Symptomatic treatment of Hypoxemia
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O2 Therapy
treats the lack of O2 not the underlying cause -B. Spasms -Increased Secretions -Airway Edema |
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Definitive Treatment for O2 Therapy
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Treat the underlying cause
-B. Dialators -Cough/Clearance -Steroids |
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O2 Content Calc.
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O2 dissolved in plasma + O2 Bound to Hb
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O2 dissolved in plasma calc.
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PaO2 x 0.0031
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O2 Bound to Hb calc.
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Hb x 1.34 x SaO2 (decimal)
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How much oxygen does the tissue use?
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3.5% - 5%
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How long will it take for COHb to decrease by half?
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5-6 hrs on RA
90 mins on 100% O2 23 mins on 100% O2 and Hyperbaric Chamber at 3 ATM of pressure |
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Causes of Acute Lung Injury
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(ALI)
Aspiration of vomit Mechanical Ventilation Chest Trauma Sepsis |
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Mortality Rate of ARDS
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30%-50%
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Criteria for ALI
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Acute onset
-24-72 hrs while on 100% Bilateral alv. infiltration on frontal chest x-ray -"white out" Degree of Oxygenation failure -PaO2/FIO2 equal to or less than 300 Pt. Cannot have CHF -PCWP equal to or less than 18mm Hg. And no evidence or left atrial or left ventricular HTN |
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Criteria for ARDS
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Only difference between ALI and ARDS is the P/F ratio has to be less than or equal to 200
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Most common cause of Hypoxemic Hypoxia
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"Shunt-like" V/Q Mismatch (Limited Vent.
-Broncho Spasm (Asthma) -Secretions (COPD) -Airway Edema |
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Indications for O2 Therapy in Neonates (< or equal to 28 days)
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PaO2 < 50mm Hg
SaO2 < 88% PcapO2 < 40 mm Hg Infants > 28 days < 1 year dealt with individually |
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Treatment for Subcutaneous Emphysema
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Give pt 100% O2, any air trapped will become higher than arterial pressure and will be reabsorped
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If you have more than one pt whos O2 needs to be adjusted...
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Always treat the pt that needs increased support first
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PCR Stimulation
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PaO2 <500 to 30 mm Hg
-Max 40-60 mm Hg -Min. < 30 mm Hg Decreased pH Elevated PCO2 Decreased blood flow, (CO) Increased Temp Possibly stimulated by Low Cardiac Output states |
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What is the normal Vent. Response to Metabolic Acidosis?
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Hyperventilation
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PCR are not stimulated by
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Abnormal Hb
Inadequate Hb Histotoxic Hypoxia |
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Measurable signs of Hypoxemia
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Increased RR, Vt, MV
Increased HR, FOC, CO |
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MetHb
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Caused by Nitric Oxide Exposure or No poisoning from fertilizer
Treatment: Methylene Blue Maintain acceptable oxygenation |
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Stagnant Hypoxia
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Inadequate CO for perfusion to tissues
Causes -Altered Blood vol -Altered vascular resistance -Inadequate pump |
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Altered Blood Vol.
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Not enough fluid
-give the pt fluids and then give them a diuretic to make them pee Too much Fluid -Fluid resuscitate them |
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Vascular Resistance
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Normal SVR
-770-1500 dynes/sec/cm5 Vasodialator -Nitroglycerin -Nitroprusside Normal PVR -100-250 dynes/sec/cm5 Vasoconstrictor -Norepinephrine (Levophed) |
